JOHNSON CONTROLS
16
FORM 155.17-N1
ISSUE DATE: 4/1/2013
FORM 155.17-CL1
ISSUE DATE: 8/31/2012
With reference to the terms of the above contract, we are requesting the presence of your JCI Authorized Representative at the job site on
______ / ______ / ______ to start the system and instruct operating personnel. Have the JCI representative contact: ____________________________________
We understand that the services of the Johnson Controls Authorized Representative will be furnished in accordance with the contract for a period of time of not
more than _______ consecutive normal working hours, and we agree that a charge of _________ per diem plus travel expenses will be made to Johnson Controls
if services are required for longer than ________ consecutive normal hours or if repeated calls are required, through no fault of Johnson Controls.
Month Day Year
Name/Phone
Customer/Contractor Signature: _______________________________________
Form Completed by: _______________________________________
_______________________________________Title:
CONTRACTOR'S RESPONSIBILITIES AND INSTRUCTIONS TO USE FORM
This installation checklist provides a quick way to check if all necessary installation work was completed in accordance with
all applicable installation instructions.When completed, this form acts as a request for Johnson Controls to furnish start-up
supervision.
Complete this form as follows:
1. Fill out the top of the page.
2. Check off each item as required. Cross out (x) items that do not apply.
3. Enter names and phone numbers of the operating personnel who completed the checklist.
4. Bottom of Form: Enter the date that the Johnson Controls start-up technician should be at the job site and the name(s)
of the supervisor(s) to be contacted.
5. Retain one copy in les and send one copy to customer.